Author Topic: Question about Harvoni & Milk (Read 22511 times)

KimInTheForest · « **on:** March 21, 2015, 02:30:45 pm »

What have your doctors or Gilead advised you about having milk while on Harvoni? Total ban on milk? A little milk in coffee okay? Separate by four hours? Non-issue?

I hope to start on Harvoni in May. I see that it must not be taken with antacids or calcium supplements because it requires an acidic environment to be effective. Yesterday, someone here posted that their doctor had told them no milk within 4 hours of Harvoni. Which makes sense. But since I plan to take my Harvoni in the morning, it will be a huge struggle not to have my usual wake-up beverage of tea+milk or coffee+milk for 12 weeks.

Also, for the Ribavirin in my tx, I wanted to take it with oatmeal each morning to have something solid in my stomach. Oatmeal requires milk. I know there are milk substitutes (almond milk, rice dream, soya milk, etc.). But many of those are fortified with calcium, so same problem. And even if I find one that isn’t, I have never been able to use them in coffee or cereal. Tastes like crap as a milk substitute. (ok as a stand-alone beverage.)

How are the rest of you handling the milk issue? What protocols are you following and what advice have you been given?

Thanks!
Kim ☺

dragonslayer · « **Reply #1 on:** March 21, 2015, 03:12:37 pm »

So far as I know, Gilead has made no proscriptions with regard to food and Harvoni, milk included.

KimInTheForest · « **Reply #2 on:** March 21, 2015, 03:45:08 pm »

Quote from: dragonslayer on March 21, 2015, 03:12:37 pm

So far as I know, Gilead has made no proscriptions with regard to food and Harvoni, milk included.

Thanks Paul.

Still, if Calcium supplements are ill-advised (at least in close proximity to Harvoni pill time), then one has to wonder about milk and other dairy products. Gilead is rewriting its protocols and advice and warnings all the time on its newest drugs as new data comes in...

dragonslayer · « **Reply #3 on:** March 21, 2015, 03:49:39 pm »

Quote from: KimInTheForest on March 21, 2015, 03:45:08 pm

Thanks Paul.

Still, if Calcium supplements are ill-advised (at least in close proximity to Harvoni pill time), then one has to wonder about milk and other dairy products. Gilead is rewriting its protocols and advice and warnings all the time on its newest drugs as new data comes in...

Well, Gilead doesnt advise against calcium with harvoni either, so far I as I can find. I take Levothyroxine for hypothyroid, and there they do have a proscription against calcium, and a 4 hr window surrounding it.. However, even there, milk does not have a concentration that is deemed to be problematic. Calcium supplements typically have about 600mg or aobut 60% of the rda; Milk lists calcium at about 33% rda. I think thats where the difference is. If folks feel better about separating milk intake and meds, thats fine... Im not sure its mandatory however.

Lynn K · « **Reply #4 on:** March 21, 2015, 04:04:08 pm »

It is the negative ion component of antacid that reduce stomach acid it is not the calcium or the magnesium it is the carbonate molecule in antacids that act to reduce stomach acid. The calcium in milk is elemental calcium not the positive ionized form found in antacids ie calcium carbonate (CaCO3) where Calcium (Ca) is a positively charged ion and the carbonate (CO3) is the negatively charged ion. It is the CO3 that reacts with the stomach acid to reduce acid levels.

Just as sodium is a metal in elemental form and chloride is a gas in it's elemental form when they combine ionically they react to form common salt. Another example is elemental hydrogen and oxygen gasses which react to form a molecule we are all familiar with H2O or water.

There is nothing in the prescribing information about milk or calcium it is the acid reducing capacity of the CO3 in antacids that is of concern as it will reduce levels of the Ledipasvir component of Harvoni as Ledipasvir is less soluble in a lowered acid environment.

Hope that helps

KimInTheForest · « **Reply #5 on:** March 21, 2015, 04:12:02 pm »

Thanks Lynn. That is useful. It does appear to be true though that calcium supplements (or at least those containing calcium carbonate, which some supplements do) are counter-indicated with Harvoni. Page 3 of this document:

https://www.medicines.org.uk/emc/PIL.29468.latest.pdf

But like you were saying, that has to do with the carbonate component. (The document doesn't specifically mention calcium supplements. but calcium carbonate is the form of calcium in some people's calcium supplements.)

So in short, Lynn… you don't see any problem in taking milk/yogurt/cheese at same time as Harvoni? That would certainly make my life easier during my 12 weeks.

Thanks all. Great to have a place to come ask questions & share info!

Kim

Lynn K · « **Reply #6 on:** March 21, 2015, 04:24:33 pm »

I asked my nurse at the liver center at Swedish hospital Seattle she said don't drink a gallon of milk with Harvoni drinking milk does little to lower stomach acid an actually like any food will cause an increase in stomach acid to digest the food.

The concern is antacids not milk not dairy those are not listed on the prescribing information sheet only antacids as well as proton pump inhibitors (PPI) like PRILOSEC and similar as well as another group H2 inhibitors like Zantac and similar.

I am not a medical professional for a best answer ask either support path or your doctor's office

KimInTheForest · « **Reply #7 on:** March 21, 2015, 04:47:53 pm »

Thanks very much Lynn for your thorough explanation of ions and ionic forms of calcium.

I think I've got a handle on this now. Relieved to know that milk and dairy products are probably ok. But yes, will ask my doctor's office when my own tx starts in May.

Very thankful that these forums exist where these questions can be posted.

Kim

DisabledHepcat · « **Reply #8 on:** March 21, 2015, 11:04:41 pm »

I saw that calcium affected Harvoni after looking at this
http://www.drugs.com/drug-interactions/ledipasvir-sofosbuvir,harvoni.html
along with caffeine, aspirin and a slew of other medications so I stopped taking a multivitamin which is mostly calcium carbonate. (listed numerous times in the moderate interactions)
I use whey protein isolate for my milk with cereal.
MUST BE ISOLATE -- Whey concentrate give you gas.
I just put some cold water in a bowl, add the whey and stir it up a bit and add my cereal. You will get 25-30 grams of whey protein that the liver loves.
The interactions never said anything about Miller High Life so I did that instead of a pain releiver such as aspirin - LOL

Lynn K · « **Reply #9 on:** March 22, 2015, 01:04:57 am »

Yes the carbonate CO3 ion reduces stomach acid and raises pH levels reducing solubility of Ledipasvir which is the issue

KimInTheForest · « **Reply #10 on:** March 22, 2015, 02:48:49 am »

Thanks for the tip about whey protein isolate for milk substitute, hepcat. I will look into that. Have never tried it.

kim

atomic dog · « **Reply #11 on:** March 29, 2015, 01:37:51 pm »

On that note, I notice that several people on the forum use Tums in place of other antacids, yet Tums is calcium carbonate. True? Wouldn't that make Tums contraindicated?

KimInTheForest · « **Reply #12 on:** March 29, 2015, 02:41:25 pm »

I personally believe Tums is contraindicated with Harvoni. I have seen several people here say that their doctor has told them not to take Tums within 4 hours either side of Harvoni.

Kim

MEG · « **Reply #13 on:** March 29, 2015, 03:00:37 pm »

I agree with Lynn's detailed post on this upthread.

Tums---together with Harvoni is a no-no...

For people who are really suffering with unbearable acid problems, the doctors have them take the Tums no sooner than 4 hours after Harvoni or take a daily Prilosec type proton pump inhibitor with the Harvoni......this is counterintuitive. But Prilosec's lowest level is at the 24 hour mark. So taking them together works....

All this said, I would not take Tums or any acid reducing agents unless 1) it was unbearable 2) your hepatologist and or Gilead advised you.

Acid-neutralization in your stomach is a sure way to render Harvoni ineffective...;-(

I also asked about milk and yogurt and my doc concurred with Lynn--it's fine.

So many variables to juggle!

KimInTheForest · « **Reply #14 on:** March 29, 2015, 03:11:52 pm »

Thank you Meg for your input. Really glad to hear (from several of you now) that milk is fine while on Harvoni. I would not welcome eliminating dairy for 12 weeks.

Wellness to all,
Kim

Lynn K · « **Reply #15 on:** March 29, 2015, 06:30:52 pm »

I think maybe the milk concern is because certain antibiotics cannot be taken with milk which the calcium in milk does actually chemically bond with the antibiotic decreasing its effectiveness.

I have been having a bad cold/cough recently so my GP prescribed an antibiotic with those instructions. It would not surprise me if someone confused the instructions for an anti VIRAL Harvoni with the milk warning for an anti BIOTIC medicine.

KimInTheForest · « **Reply #16 on:** March 29, 2015, 07:59:15 pm »

That is probably true, Lynn - about people confusing antibiotic instructions of no milk. However, for me it was seeing the warning against antacids and calcium carbonate while on Harvoni that made me worry about any source of calcium. But very relieved to know I'm in the clear there.

kim

skycatcher · « **Reply #17 on:** April 01, 2015, 03:17:38 pm »

Hi KimIn the Forrest!
Now for what's it's worth the Rx Lady from the Specialty Pharmacy that I spoke with suggested to me that I not take my Harvoni with milk. She indicated that there may be some reduction in absorption or a binding with the med. It is interesting that no one else has received that info but there it is. The Lady that told me that is thought of very highly by my Doctor.
I was reading Lynn's explanation and that makes a lot of sense. For me personally it has been a challenge that gave me an opportunity to rethink my breakfast menu. And I must say I have been enjoying my new menu - minus dairy for the AM.

DisabledHepCat thanks for your suggestion about the whey powder. Is that something I could get at the Health food store? Is it gritty?

Also the Ph. of milk is slightly acidic (I was surprised by that). For me I am going to continue to avoid the dairy in the AM because this is a unique time in my life and even though my Doc would like to treat for 12 weeks verses 8 weeks the insurance co is pushing for the shorter time. If I only get 8 weeks of Harvoni I don't want to do anything that will reduce my chance for a complete clearing of CHCV from my body. I am half way there.

So that is the information that I have. For the first week I used applesauce with my lovely oatmeal and lots of fresh berries. I went to rice milk (the Original -- less vitamins) and this week Almond milk. But I have wondered about these drinks so
Big Thanks to HepCat. I will see what I can find.

It really comes down to the decisions we make and the ones we can live with. I think Lynn's explanation is a perfectly reasonable one. Makes a lot of sense. For me I have made a commit to myself to avoid dairy first thing and I have also stopped my multivitamin. Just for now. If I don't take it early in the day it can keep me awake. So for now I will just skip it. I think by doing this I will place less stress on my liver. I had read someone on this sight had posted they were doing that and at first I though" Why stop a multivitamin?" As I though about it made a great deal of sense to me.

So this is what I am doing and I feel very happy about my decisions. These are all very individual things and we are the first really large group of "test" subjects. You will do what is right for you and you are being very vigilant. Ask those questions. Maybe make a list so that when you get the opportunity yon can asks all of your questions to your various providers. I have found that I can ask the same question to many and always get different answers -- eventually arriving at THE answer. I think what HepCat is referencing is important also.

Sound like you have a while before you jump so you will get to a place that works for you.
~ Skycatcher

Lynn K · « **Reply #18 on:** April 01, 2015, 03:27:57 pm »

Well I gave up my PRILOSEC even though per the instructions technically I could but as my schedule is all over the place takng both together on an empty stomach for me is somewhat problematic so I just gave up the PRILOSEC better safe as you say

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